Pancreatic cancer

On this page: The pancreas | What is pancreatic cancer? | What types are there? | How common is it? | What are the causes? | What are the symptoms? | Which health professionals will I see? | Reviewers

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The pancreas

The pancreas is an organ in the digestive system that produces enzymes, which break down food so it can be absorbed and used by the body. It's a thin, lumpy gland about 13cm to 15cm long that lies between your stomach and spine. The pancreas is divided into:

• a large rounded section, called the head of the pancreas
• the middle part, known as the body
• the narrow end, called the tail.

A tube called the pancreatic duct connects the pancreas to the first part of the small bowel (duodenum). Another tube called the common bile duct joins the pancreatic duct and connects the liver and gall bladder to the small bowel. The common bile duct carries bile, a substance that helps to digest fats.

The pancreas contains two types of glands: the exocrine glands and the endocrine glands. These glands release substances that help with digestion.

1. Exocrine glands: produce juices called enzymes that help break down your food. The juices flow from the pancreas into your duodenum through the pancreatic duct. Most of the pancreas is made up of exocrine glands.
2. Endocrine glands: are scattered amongst the exocrine glands in small clusters called pancreatic islets (or islets of Langerhans). They release chemical messengers (hormones) that control the amount of sugar in the blood. The hormone insulin decreases blood sugar levels, while the hormone glucagon increases blood sugar levels.

What is pancreatic cancer?

Pancreatic cancer occurs when malignant cells develop in part of the pancreas. This may affect the normal functioning of the pancreas, including the way the exocrine or endocrine glands work.

About 70% of pancreatic cancers are located in the head of the pancreas. This can block the common bile duct, which will decrease the flow of bile and cause a build-up of bile pigment in the blood. This is known as jaundice.

Cancer can also spread to nearby lymph nodes (part of the immune system), blood vessels or nerves. It may travel through the bloodstream to other parts of the body, such as the liver.

What types are there?

There are two types of pancreatic tumours:

1. Exocrine tumours: More than 90% of pancreatic tumours. The most common exocrine tumour, called an adenocarcinoma, begins in the lining of the pancreatic duct. Other types of tumours include adenosquamous carcinomas and undifferentiated carcinomas.
2. Pancreatic neuroendocrine tumours (PNETs): Rare types of tumours affecting the endocrine system. The glands in the endocrine system produce hormones that control the growth of cells in the body.

PNETs are categorised as hormone secreting (functioning) or non-hormone secreting (non-functioning). Functioning tumours are usually named after the type of hormone they secrete.

Types of PNETs include:

• gastrinomas: produce too much gastrin
• insulinomas: produce too much insulin
• glucagonomas: produce too much glucagon
• somatostatinomas: produce too much somatostatin
• VIPomas: create a hormone-like substance called vasoactive intestinal polypeptide (VIP).

Neuroendocrine tumours can also affect other areas of the body, including the lungs, kidneys and bowel. These pages have information about neuroendocrine tumours affecting the pancreas. For information about other types of tumours, contact the Unicorn Foundation on 1300 2873 6387 or Cancer Council Helpline 13 11 20.

How common is it?

About 2,500 Australians are diagnosed with exocrine pancreatic cancer each year. The average age of people diagnosed with this cancer is 71. It's the twelfth most common cancer in men and ninth most common cancer in women.

PNETs are very rare. Less than 100 people in Australia are diagnosed with a PNET each year.

What are the causes?

Pancreatic cancer is caused by abnormally functioning genes. This may be brought on by environmental or genetic risk factors, or a combination of the two.

Research has shown that people with certain risk factors are more likely than others to develop pancreatic cancer. Risk factors include:

• getting older: it's most common in people over 65
• smoking: cigarette smokers are 2 to 3 times more likely to develop pancreatic cancer
• new onset diabetes: about 15% to 20% of people with pancreatic cancer have newly diagnosed diabetes
• chronic inflammation of the pancreas (pancreatitis)
• a family history of inherited cancer syndromes.

The importance of family history

Most people with pancreatic cancer don't have a family history of the disease. However, about one in 10 people who develop pancreatic cancer have an inherited faulty gene that increased their risk.

You may have an inherited family risk if you have two or more first-degree relatives affected by pancreatic cancer, or a history of an inherited syndrome. Some inherited syndromes that may cause pancreatic cancer include Peutz-Jeghers syndrome, the familial breast cancer gene (BRCA1 and BRCA2), familial atypical multiple mole melanoma syndrome, Lynch syndrome and hereditary pancreatitis.

The "degree of relationship" describes how many genes are shared between two blood relatives. A first-degree relative shares about half their genes with you. Examples are your parents, siblings or children.

Some PNETs are caused by a rare inherited syndrome, such as multiple endocrine neoplasia type 1 (MEN-1) or neurofibromatosis.

If you're concerned about your family history or if you want to know more about genetic testing, talk to your doctor or visit the Australian Familial Pancreatic Cancer Cohort website.

What are the symptoms?

Early stages of pancreatic cancer rarely cause symptoms. Symptoms also may be unnoticed until the cancer is large enough to affect nearby organs.

Symptoms of pancreatic cancer may include:

• indigestion
• appetite loss
• feeling sick (nausea)
• vomiting
• weight loss
• pain in the upper abdomen, side or back, which may cause you to wake up at night
• changed bowel motions – either diarrhoea, severe constipation, or stools that are pale and hard to flush away
• jaundice, which causes yellowish skin and eyes, dark urine, pale stools and itchiness
• onset of diabetes within the last two years, or worsening of existing diabetes – in up to 50% of people with pancreatic cancer, the cancer stops the pancreas from making insulin properly
• for PNETs, too much sugar in the blood (hyperglycaemia)
• for PNETs, blurred vision.

Symptoms of pancreatic cancer are also common to other conditions. See your doctor if you experience any of these symptoms.

Which health professionals will I see?

If you have cancer, one or more specialists will advise you about treatment options. You'll be cared for by a team of health professionals from the relevant major fields. This is called a multidisciplinary team.

Some people in non-metropolitan areas have to travel to appointments with specialists. Your general practitioner (GP) can be kept informed about all your test results and treatment. They may refer you to specialists and answer questions you have in-between appointments.

• gastroenterologist: specialises in diagnosing and treating diseases of the digestive system, including pancreatic cancer and blocked bile ducts
• pancreatic surgeon: specialises in surgery to the liver, pancreas and surrounding organs
• medical oncologist: prescribes and coordinates the course of chemotherapy
• radiation oncologist: prescribes and coordinates the course of radiotherapy
• endocrinologist: diagnoses and treats hormonal disorders, including diabetes
• nurses: support and assist you through all stages of your illness
• dietitian: recommends an individualised eating plan to help you manage your symptoms during and after treatment
• social worker, psychologist and occupational therapist: talk to you about support services and help you resume your activities
• palliative care team: help with symptom management and emotional support for you and your family

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